Treating hair loss

01.Introduction

There are plenty of practitioners out there promising to restore your hair and self-esteem, but in this vanity-driven industry with more than its fair share of sharks, it’s very much a case of caveat emptor. The facts are:

Hair loss and balding is not uncommon - androgenetic hair loss affects more than half of all men as well as many women at some point in their lives.

There are treatments which can slow or stop hair loss, and in some cases reverse it. However, there are plenty of shonky operators and products out there, which can be trap for the desperate.

The treatments available

Finasteride (Propecia) is a prescription medicine usually taken to treat an enlarged prostate, and works by blocking one of two enzymes (called 5-alpha reductase) that convert testosterone to dihydrotestosterone (DHT). It’s the DHT that causes hair follicles on the temples and crown to shrink, so finasteride’s action helps prevent or slow hair loss, and taken in the early stages may even regrow hair. Clinical trials have found it helps nine out of 10 men. Side effects are uncommon but may include impotence, breast cancer and depression. . It may also cause birth defects so is not recommended for women. Costs: $65-$70 per month, although your hair-loss medical specialist may determine you need it less often, which reduces the cost and risk of side effects. You’ll need to take it for at least a year to know whether it’s proving effective.

Dutasteride (Avodart) has a similar action to finasteride, but blocks both DHT-making enzymes instead of one. It may be a more effective option if finasteride isn’t working for you, although at present it’s only prescribed ‘off-label’ for hair loss.

Saw Palmetto is a herbal remedy sometimes taken instead of finasteride for treating an enlarged prostate. It was hoped it might prevent hair loss too, and is often promoted as such, but this hasn’t been shown in clinical trials so far.

Minoxidil (for example Regaine) is applied to your scalp twice daily. No one really knows how it works, but it’s thought that it increases the supply of blood and nutrients to the hair follicle, which helps strengthen existing hair, prevent loss and in some people can stimulate growth. It works best on people with recent or mild hair loss, but less effectively on people who’ve had large areas of baldness for a long period of time. It may take up to a year to see results. Hair loss will rapidly restart when you stop the medication. Costs: $15-50 per month.

Some hair loss clinics promote a pharmacist-compounded solution of minoxidil with retinoic acid, which supposedly helps the minoxidil penetrate the skin. However, there’s no good evidence it increases minoxidil’s effectiveness, and it’s more likely to irritate your scalp.

The results are in

To help consumers faced with hair loss who were tempted to try treatments, CHOICE’s sister US publication, Consumer Reports, recently surveyed more than 6000 men and close to 2000 women who’d experienced hair loss, to investigate what worked for them and what didn’t. Here’s what they found:

Two-thirds of respondents who’d taken finasteride (Propecia) were completely or somewhat satisfied with the results.

Less than a quarter of those who’d taken monoxidil (Regaine) were completely or somewhat satisfied with the results, with about half saying it wasn’t effective (although this may reflect unrealistic expectations

About half the patients who’d had hair transplant surgery were completely or very satisfied with the results.

Some people found changing their diet, increasing exercise and certain (unspecified) supplements, lotions or shampoos helpful.

What does surgery involve?

Hair transplant surgery has changed a lot in the past 20 years, and the tufty plug transplants of yesteryear have been replaced with implants of individual follicles. A surgeon cuts a strip of scalp from the side or back of your head, and the follicles are separated and inserted into the crown and temples. Sometimes, instead of a strip, individual follicles are removed and implanted.

Because the implanted follicles aren’t susceptible to DHT, the hair growing from them is permanent. However, it’s likely you’ll need to use medication to maintain remaining DHT-susceptible hairs. Some people have complained about scarring from the strip procedure, so always research the surgeon you’re thinking of using beforehand. Costs: $12,000-$18,000 on average – about $6-9 per graft, with 2000 grafts the typical scenario. The process may also need to be repeated if hair keeps thinning.

What about laser therapy?

Some clinics offer laser therapy to halt hair loss and regrow hair, while handheld devices for home use are also available. The therapy may include using minoxidil and finasteride, as well as shampoo, thickening conditioners and other products that disguise hair loss. This not only adds hundreds of dollars in ongoing costs, but also makes it difficult to tell what improvement – if any – is from which treatment, and what is merely a temporary cosmetic effect.

Unfortunately, there’s no definitive answer as to whether or not laser therapy works. It appears to stimulate follicles, and your hair will probably look healthier. However, clinical trials showing hair loss prevention and regrowth are fewer than the hairs on Homer Simpson’s head, and the ideal laser wavelength, power, length of time and frequency of application hasn’t been established.

Costs: Ongoing clinic treatment involves regular visits and amounts to thousands of dollars. Hand-held devices cost from a few hundred dollars to more than $1000.

What does Ashley & Martin do?

Ashley & Martin Medical Hair Centres have been around for more than 40 years. They offer several programs to treat hair loss, including a medications-based regime (with optional laser treatment) and follicular transplants.

According to Ashley & Martin CEO Richard Bond, the medications-based program is the most popular. Clients are given an individualised prescription-based treatment and the program costs from $1920 up to $4000. Regular fortnightly visits to the clinic are recommended and optional laser therapy is offered at no extra cost. CHOICE suggests that at these prices, it would make sense to try what your doctor has to offer before signing up for one of these programs.